Provider Demographics
NPI:1487042602
Name:AT HOME HEALTHCARE
Entity Type:Organization
Organization Name:AT HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SURGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-899-3135
Mailing Address - Street 1:1597 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4441
Mailing Address - Country:US
Mailing Address - Phone:330-899-3135
Mailing Address - Fax:330-791-1133
Practice Address - Street 1:1597 S WATER ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4441
Practice Address - Country:US
Practice Address - Phone:330-899-3135
Practice Address - Fax:330-791-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2260002251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health